Which of the following is NOT a sign of respiratory distress in a newborn?

AIIMS BBSR SNO - 2019

Child Health Nursing (Pediatrics)

Medium

Appeared in: AIIMS BBSR SNO - 2019

Explanation

A newborn's respiratory rate naturally fluctuates with their level of activity; it is faster when they are awake, crying, or feeding, and slower and more irregular when they are sleeping.
This variability is a normal physiological finding, reflecting the immaturity of the newborn's respiratory control center.
In contrast, a persistently rapid respiratory rate (tachypnea), defined as more than 60 breaths per minute while at rest, is a cardinal sign of respiratory distress.
Therefore, a respiratory rate that simply varies with activity is an expected finding and not a sign of pathology.

Option A: Cyanosis, a bluish discoloration of the skin and mucous membranes, is a significant and often late sign of hypoxemia, which is a direct consequence of respiratory distress.
Option B: Expiratory grunting is a classic sign of respiratory distress. It is an audible noise made as the infant exhales against a partially closed glottis to increase end-expiratory pressure and prevent alveolar collapse.
Option C: Sternal retractions (sinking of the chest around the sternum) indicate the use of accessory muscles for breathing. This signifies a significant increase in the work of breathing and is a hallmark of respiratory distress.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Assessment of respiratory distress in newborns as background academic context rather than a clinical decision trigger.
Early and accurate recognition of respiratory distress is a critical nursing skill, as prompt intervention can prevent progression to respiratory failure.
Nurses use scoring systems like the Downe's Score to objectively quantify the severity of respiratory distress, which includes retractions, grunting, cyanosis, air entry, and respiratory rate.
What if the newborn's respiratory rate is consistently 70 breaths/min even while sleeping? In this case, the finding is no longer normal variation. Persistent tachypnea is a cardinal sign of respiratory distress, and the nurse must investigate further and report immediately.

How to Approach the Question

First, identify the negative keyword "NOT" in the question stem. This tells you that three of the options are true signs of respiratory distress, and your task is to find the one that is not.
Next, recall the normal respiratory characteristics of a newborn. Remember that their breathing patterns are often irregular and change based on their state of arousal (sleeping, crying, feeding).
Evaluate each option against your knowledge of newborn physiology and pathology. Ask yourself, "Is this a sign of distress or a normal finding?"
Cyanosis, grunting, and retractions are all classic, textbook signs of increased work of breathing and respiratory compromise.
The option describing a variable respiratory rate linked to activity describes a normal, expected finding.
Conclude that the normal finding is the correct answer because the question asks what is NOT a sign of distress.

Concept Tested & Keywords

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E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 155-157

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 298-300

E6 Nursing Fundamentals Taylor p. 712-714